[Clinical characteristics among forensic inpatients: A special case, the establishment of social defense "Les Marronniers" in Tournai (Belgium)]. / Caractéristiques cliniques d'une population internée : un cas particulier, l'établissement de défense sociale « Les Marronniers ¼ à Tournai (Belgique).

BACKGROUND: In Belgium, the law of "social defense" stipulates that an accused "which is either in a state of dementia or in a serious state of mental disturbance or mental deficiency, incapable of controlling his actions" can be interned. The establishment of social defense (ESD) in Tournai (Belgium) hosts 350 inmates. OBJECTIVES: In collaboration with the Centre for research in social defense, we organized a systematic assessment of patients interned in ESD. This is the first study evaluating prospectively this population. METHODS: Of the total, 229 patients signed informed consent. Different scales of assessment (MINI, WAIS-III, SCID II) were used. Descriptive analyzes were applied (SPSS version 12). RESULTS: We show that 48.8 % of our participants had committed a sexual offense (rape or attempted rape, indecent assault, public outrage or mixed). The average intelligence quotient is 71.4. According to the MINI, 33.2 % of participants showed no psychiatric disorder. Among psychiatric disorders, psychotic disorders are the most represented (37.4 %). According to the SCID, personality disorders were absent in 26.8 % of our participants. Most of the axis II disorders are represented personality disorders related to cluster B (57.3 %) mainly with antisocial personality disorder (37.9 %). CONCLUSION: These data demonstrate the significant heterogeneity of our sample and the need for the establishment of specific care routes to each subpopulation.

[Psychopathy and associated personality disorders: searching for a particular effect of the borderline personality disorder?]. / Psychopathie et troubles de la personnalité associés : recherche d'un effet particulier au trouble borderline ?

INTRODUCTION: Recent clinical and empirical works are based on Cleckley's clinical observations in which psychopathy is viewed as a personality disorder, characterised by a lack of emotions, callousness, unreliability and superficiality. Hare operationalised Cleckley's concept of psychopathy by developing the Psychopathy Checklist-Revised composed of 20 items that load on two factors in majority: factor 1 (personality aspects of psychopathy) and factor 2 (behavioural manifestations), close to the antisocial personality disorder (DSM-IV criteria). Comorbidity is strong with antisocial personality disorder but also with histrionic, narcissistic and borderline disorders. OBJECTIVES: As results of categorical studies relative to comorbidity suggest a strong comorbidity between psychopathy and other personality disorders, and particularly cluster B disorders (axis II, DSM-IV), this study assesses the relationships between psychopathy (dimensional approach) and personality disorders (categorical approach) and particularly with the borderline personality disorder. The aim of this study is also to underline the complementarity of categorical (SCID-II) and dimensional approaches (PCL-R), and the utility of the standardised clinical examination. DESIGN OF THE STUDY: We hypothesised positive associations between psychopathy and other personality disorders, mainly with the cluster B axis II (narcissistic, antisocial, histrionic, and borderline). Among those disorders, a particular link exists with the borderline personality disorder, considering that their association may attenuate the pathological level of the psychopathy. The sample included 80 male inmates from French prisons (age: M=31.48; SD=11.06). Each participant was evaluated with the PCL-R to assess the level of psychopathy and the SCID-II to assess the possible presence of personality disorders. The MINI and the WAIS-III were used to exclude respectively those who presented an axis I comorbidity (mood disorders and psychotic disorders established at the moment of the testing), or a backwardness (IQ<70). Correlations and multiple linear regressions analysis (with the Stepwise procedure) were used to analyse the data. RESULTS: As expected, the results suggested positive correlations between narcissistic, antisocial personalities and scores of psychopathy (from 0.36 to 0.63); paranoid personality was less expected (from 0.32 to 0.47). Borderline personality was associated with both the total score of psychopathy (0.24) and the score of factor 2 (0.30). Linear regression analysis revealed that the antisocial and paranoid personalities predicted the total score (R(2)=38%) and the factor 2 (R(2)=45%) of the PCL-R. Antisocial and narcissistic personalities predicted factor 1 (R(2)=22%). However, in the different models, contrary as predicted, the borderline personality was not a significant predictor. CONCLUSION: First, these results underline the importance of impulsivity above all for the cluster B personality disorders and secondly, the importance of considering impulsivity with antisocial (factor 2), narcissistic and paranoid characteristics. Moreover, because of the transversality of impulsivity, the literature outlined the cross-over between cluster B disorders and psychopathy. These different studies could have important clinical consequences (risk of violence, therapeutic indications and forecast). These results also emphasize the necessity of standardised examinations. Implications for treatment are outlined: the treatment may be adapted according to the comorbidities having an effect on psychopathy that is antisocial with paranoid personalities, and antisocial with narcissistic personalities.

Evaluation of the SORAG and the Static-99 on Belgian sex offenders committed to a forensic facility.

This study evaluated the convergent and predictive validity of the Sex Offender Risk Appraisal Guide (SORAG; V. L. Quinsey, G. T. Harris, M. E. Rice, & C. A. Cormier, 1998) and the Static-99 (R. K. Hanson & D. Thornton, 1999, 2000) among 147 male sex offenders committed to a high-security hospital in Belgium (Centre de Défense Sociale "Les Marronniers"). Of the sample, 63.8% were child abusers (victims under 14 years of age), 24.6% were rapists (victims aged 14 years or more), and 11.5% were mixed-victim offenders (victims less than 14 years of age and victims aged 14 years or more). After an average follow-up period of 4.2 years (SD = 3.4 years), the sexual recidivism rate was 25.2%, the violent recidivism rate was 17.1%, and the general (any) recidivism rate was 33.1%. The SORAG and the Static-99 were moderately correlated with each other (r = .55), and both showed strong predictive validity for general and violent recidivism (ROC AUC's ranging from .68 to .72 for the total sample). Both instruments showed moderate predictive validity for sexual recidivism (AUC of .64 for SORAG and .66 for Static-99).